The aortic wall consists of an innermost layer the intima (consisting of endothelial cells), middle layer the media (consisting of elastic collagen fibers and smooth muscle fibers), and an outer layer the adventitia (consisting of fibrous connective tissue with blood vessels). The aortic intima is separated from the media by internal elastic membrane and the media from adventitia by the external elastic membrane.

Figure 4.2A. Autopsy specimen of the heart with the entire thoracic aorta demonstrates a ruptured ascending aortic dissection. Note that the white tubular marker demonstrates the site of the intimal tear (entry site) just below the origin of innominate artery as well as the rupture of the false lumen (dark with clotted blood) in to the mediastinum. The false lumen extends proximally to the aortic anulus and distally to the origin of the left subclavian artery. This demonstrates the importance of looking for the primary entry site.

Figure 4.2B. Gross specimen and the sectioned specimen demonstrating dissecting aneurysm with blood clot in the media resulting from hemorrhage (intramural hematoma).

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